E. He1,3, A. N. Kothari1,3, M. De Jong2, R. Yau1,3, J. Eberhardt1, T. Saclarides1, P. C. Kuo1, D. Hayden1 1Loyola University Medical Center,Surgery,Maywood, ILLINOIS, USA 2Loyola University Chicago,Health Sciences Division,Maywood, ILLINOIS, USA 31:Map Surgical Analytics Group,Maywood, IL, USA
Introduction:
As the population ages, more surgeons will find themselves operating on older patients who require special preoperative evaluation and discussion of postoperative risks and expectations. We hypothesize that different age groups within the geriatric population have differing patient predictors for mortality that may help to guide their care.
Methods:
The Health Care Utilization Product State Inpatient Database (HCUP SID) for Florida from 2008-2013 was queried using ICD-9-CM codes. All patients older than 65 years who underwent elective colon resection for cancer were included. Mixed effects logistic regression was performed to determine the impact of patient demographics, comorbidities as well as post-operative complications on inpatient mortality.
Results:
12,945 patients ≥65 underwent colon resection during our study period. Patients were divided into three age groups: 65-79 (n=8411), 80-89 (n=4038), ≥90 (n=496). The average age for each group was 72.1, 83.7, and 91.2 years. Patients ≥90 had more comorbidities than the youngest cohort: anemia (47.2% vs. 28.9%, p<0.001), congestive heart failure (15.5% vs. 5.4%, p<0.001), chronic renal failure (12.5% vs. 6.7%, p<0.001), and malnutrition (9.7% vs. 3.8%, p<0.001). The youngest group had a higher incidence of chronic lung disease (18.6% vs. 15.7%, p<0.001). The average length of stay for each group was 6.9, 7.9, and 8.1 days (p<0.001). Post-operatively, the oldest patients were more likely to experience pulmonary failure (7.1%, p<0.001), MI (1.6%, p<0.001), acute renal failure (7.1%, p<0.001), and pneumonia (4.0%, p<0.001) compared to those aged 65-79 and 80-89. Mortality was 1.0%, 2.5%, and 3.6% in each group respectively (p<0.001). We examined the impact of the above characteristics on the odds of mortality following surgery for each age group using multivariable modeling. A representative sample of the most significant patient-level determinants is reported in Table 1.
Conclusion:
We have demonstrated significant variability of patient-related factors affecting mortality between age groups within the geriatric population. Respiratory failure in the immediate post-operative period is a significant predictor for mortality in all age groups. Post-operative ARF was associated with increased mortality in the two younger age groups while post-operative MI was only significant in those patients ages 65-79. These findings can be used to develop a more sophisticated prediction tool that will impact clinical decision-making and may improve outcomes for older patients undergoing elective colon cancer surgery.
